Systematic Review of Family Functioning in Families of Children and Adolescents With Chronic Pain


      Disturbances in family functioning have been identified in youth with chronic pain and are associated with worse child physical and psychological functioning. Assessment measures of family functioning used in research and clinical settings vary. This systematic review summarizes studies investigating relationships among family functioning, pain, and pain-related disability in youth with chronic pain. Sixteen articles were reviewed. All studies were cross-sectional; 7 utilized between-group comparisons (chronic pain versus healthy/control) and 12 examined within-group associations among family functioning, pain, and/or pain-related disability. Studies represented youth with various pain conditions (eg, headache, abdominal pain, fibromyalgia) ages 6 to 20 years. Findings revealed group differences in family functioning between children with chronic pain and healthy control subjects in 5 of 7 studies. Significant associations emerged among family variables and pain-related disability in 6 of 9 studies with worse family functioning associated with greater child disability; relationships between family functioning and children's pain were less consistent. Different patterns of results emerged depending on family functioning measure used. Overall, findings showed that families of children with chronic pain generally have poorer family functioning than healthy populations and that pain-related disability is more consistently related to family functioning than pain intensity.


      This review highlights the importance of family factors in pain-related disability in youth with chronic pain. Results suggest that family-level variables may be an important target for intervention. Family functioning measures showed significant variation, and researchers should take this into account when selecting instruments for use in research and clinical settings.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Alderfer MA, Fiese BH, Gold JI, Cutuli JJ, Holmbeck GN, Goldbeck L, Chambers CT, Abad M, Spetter D, Patterson J: Evidence-based assessmentin pediatric psychology: Family measures. J Pediatr Psychol 33:1046-1061; discussion 1062-4, 2008

        • Anttila P.
        • Sourander A.
        • Metsahonkala L.
        • Aromaa M.
        • Helenius H.
        • Sillanpaa M.
        Psychiatric symptoms in children with primary headache.
        J Am Acad Child Adol Psych. 2004; 43: 412-419
        • Barakat L.P.
        Editorial: Journal of Pediatric Psychology statement of purpose: Ssection on family influences and adaptation.
        J Pediatr Psychol. 2008; 33: 26-30
        • Conte P.M.
        • Walco G.A.
        • Kimura Y.
        Temperament and stress response in children with juvenile primary fibromyalgia syndrome.
        Arthritis Rheum. 2003; 48: 2923-2930
        • Eccleston C.
        • Crombez G.
        • Scotford A.
        • Clinch J.
        • Connell H.
        Adolescent chronic pain: Patterns and predictors of emotional distress in adolescents with chronic pain and their parents.
        Pain. 2004; 108: 221-229
        • Eccleston C.
        • Jordan A.
        • McCracken L.M.
        • Sleed M.
        • Cornell H.
        • Clinch J.
        The Bath Adolescent Pain Questionnaire (BAPQ): Development and preliminary psychometric evaluation of an instrument to assess the impact of chronic pain in adolescents.
        Pain. 2005; 118: 263-270
        • Eccleston C.
        • Wastell S.
        • Crombez G.
        • Jordan A.
        Adolescent social development and chronic pain.
        Eur J Pain. 2008; 12: 765-774
        • Epstein N.B.
        • Baldwin L.M.
        • Bishop D.S.
        The McMaster Family Assessment Device.
        J Marital Fam Ther. 1983; 9: 171-180
        • Gauntlett-Gilbert J.
        • Eccleston C.
        Disability in adolescents with chronic pain: Patterns and predictors across different domains of functioning.
        Pain. 2007; 131: 132-141
        • Hunfeld J.A.
        • Perquin C.W.
        • Duivenvoorden H.J.
        • Hazebroek-Kampschreur A.A.
        • Passchier J.
        • van Suijlekom-Smit L.
        • Wvan der Wouden J.C.
        Chronic pain and its impact on quality of life in adolescents and their families.
        J Pediatr Psychol. 2001; 26: 145-153
        • Iobst E.A.
        • Nabors L.A.
        • Brunner H.I.
        • Precht B.
        Pain, fatigue, family functioning, and attitude toward illness in children with juvenile rheumatic diseases.
        J Dev Physical Disab19. 2007; : 135-144
        • Jordan A.
        • Eccleston C.
        • Crombez G.
        Parental functioning in the context of adolescent chronic pain: A review of previously used measures.
        J Pediatr Psychol. 2008; 33: 640-659
        • Kashikar-Zuck S.
        • Lynch A.M.
        • Slater S.
        • Graham T.B.
        • Swain N.F.
        • Noll R.B.
        Family factors, emotional functioning, and functional impairment in juvenile fibromyalgia syndrome.
        Arthritis Rheum. 2008; 59: 1392-1398
        • Kaufman K.L.
        • Cromer B.
        • Daleiden E.
        • Zaron-Aqua A.
        • Aquq K.
        • Greeley T.
        • Li B.U.
        Recurrent abdominal pain in adolescents: Psychosocial correlates of organic and nonorganic pain.
        Child Health Care. 1997; 26: 15-30
        • Kroner-Herwig B.
        • Heinrich M.
        • Morris L.
        Headache in German children and adolescents: A population-based epidemiological study.
        Cephalalgia. 2007; 27: 519-527
        • Larsson B.
        • Sund A.M.
        Emotional/behavioural, social correlates and one-year predictors of frequent pains among early adolescents: Influences of pain characteristics.
        Eur J Pain. 2007; 11: 57
        • LeResche L.
        • Mancl L.A.
        • Drangsholt M.T.
        • Saunders K.
        • Korff M.V.
        Relationship of pain and symptoms to pubertal development in adolescents.
        Pain. 2005; 118: 201-209
        • Liakopoulou-Kairis M.
        • Alifieraki T.
        • Protagora D.
        • Korpa T.
        • Kondyli K.
        • Dimosthenous E.
        • Christopoulos G.
        • Kovanis T.
        Recurrent abdominal pain and headache: Psychopathology, life events and family functioning.
        Eur Child Adolesc Psychol. 2002; 11: 115-122
        • Logan D.E.
        • Guite J.W.
        • Sherry D.D.
        • Rose J.B.
        Adolescent-parent relationships in the context of adolescent chronic pain conditions.
        Clin J Pain. 2006; 22: 576-583
        • Logan D.E.
        • Scharff L.
        Relationships between family and parent characteristics and functional abilities in children with recurrent pain syndromes: An investigation of moderating effects on the pathway from pain to disability.
        J Pediatr Psychol. 2005; 30: 698-707
        • Miller I.W.
        • Epstein N.B.
        • Bishop D.S.
        • Keitner G.I.
        The McMaster Family Assessment Device: Reliability and validity.
        J Marital Fam Ther. 1985; 11: 345-356
        • Mitchell M.J.
        • Lemanek K.
        • Palermo T.M.
        • Crosby L.E.
        • Nichols A.
        • Powers S.W.
        Parent perspectives on pain management, coping, and family functioning in pediatric sickle cell disease.
        Clin Pediatr. 2007; 46: 311-319
        • Moos R.H.
        • Moos B.S.
        Family Environment Scale manual.
        Counseling Psychologists Press, Palo Alto1981
        • Olson D.H.
        • Portner J.
        • Lavee Y.
        FACES-III: Family Adaptability and Cohesion Evaluation Scales.
        Family Social Science, University of Minnesota, St Paul1985
        • Palermo T.M.
        • Chambers C.T.
        Parent and family factors in pediatric chronic pain and disability: An integrative approach.
        Pain. 2005; 119: 1-4
        • Palermo T.M.
        • Putnam J.
        • Armstrong G.
        • Daily S.
        Adolescent autonomy and family functioning are associated with headache-related disability.
        Clin J Pain. 2007; 23: 458-465
        • Palermo T.M.
        • Witherspoon D.
        • Valenzuela D.
        • Drotar D.
        Development and validation of the Child Activity Limitations Interview: A measure of pain-related functional impairment in school-age children and adolescents.
        Pain. 2004; 109: 461-470
        • Place M.
        • Hulsmeier J.
        • Brownrigg A.
        • Soulsby A.
        The Family Adaptability and Cohesion Scale (FACES): An instrument worthy of rehabilitation?.
        Psychol Bull. 2005; 29: 215-218
        • Reid G.J.
        • Lang B.A.
        • McGrath P.J.
        Primary juvenile fibromyalgia: Psychological adjustment, family functioning, coping, and functional disability.
        Arthritis Rheum. 1997; 40: 752-760
        • Ross C.K.
        • Lavigne J.V.
        • Hayford J.R.
        • Berry S.L.
        • Sinacore J.M.
        • Pachman L.M.
        Psychological factors affecting reported pain in juvenile rheumatoid arthritis.
        J Pediatr Psychol. 1993; 18: 561-573
        • Roth-Isigkeit A.
        • Thyen U.
        • Stoven H.
        • Schwarzenberger J.
        • Schmucker P.
        Pain among children and adolescents: Restrictions in daily living and triggering factors.
        Pediatrics. 2005; 115: e152-e162
        • Sanders M.R.
        • Shepherd R.W.
        • Cleghorn G.
        • Woolford H.
        The treatment of recurrent abdominal pain in children: A controlled comparison of cognitive-behavioral family intervention and standard pediatric care.
        J Consult Clin Psych. 1994; 62: 306-314
        • Schanberg L.E.
        • Keefe F.J.
        • Lefebvre J.C.
        • Kredich D.W.
        • Gil K.M.
        Social context of pain in children with juvenile primary fibromyalgia syndrome: Parental pain history and family environment.
        Clin J Pain. 1998; 14: 107-115
        • Scharff L.
        • Langan N.
        • Rotter N.
        • Scott-Sutherland J.
        • Schenck C.
        • Tayor N.
        • McDonald-Nolan L.
        • Masek B.
        Psychological, behavioral, and family characteristics of pediatric patients with chronic pain: A 1-year retrospective study and cluster analysis.
        Clin J Pain. 2005; 21: 432-438
        • Sheras P.L.
        • Abidin R.R.
        • Konold T.R.
        Stress Index for Parents of Adolescents, Professional Manual.
        Psych Assess Resources, Inc, Lutz, FL1998
        • Walker L.S.
        • Garber J.
        • Smith C.A.
        • Van Slyke D.A.
        • Claar R.L.
        The relation of daily stressors to somatic and emotional symptoms in children with and without recurrent abdominal pain.
        J Consult Clin Psychol. 2001; 69: 85-91
        • Walker L.S.
        • Greene J.W.
        The Functional Disability Inventory: Measuring a neglected dimension of child health status.
        J Pediatr Psychol. 1991; 16: 39-58